Intended Use Plan for the NYS Drinking Water State Revolving Fund

This form is used to gather preliminary schedule and cost information about your project. It will help us to determine project eligibility and a target date for providing your DWSRF loan. New York State Department of Health (DOH) staff may call you to verify this information and to develop a more detailed schedule for completion of all activities needed for a complete loan application. You should confer with your engineer and financial advisor regarding the schedule and cost estimate. If you have questions regarding the pre-application form, please call DOH at 518-402-7650 for assistance.

Project Information

This section of the form should include the Name of the Water System, Name of the Municipality serviced by the water system, and the County and Legislative Districts in which the project is located. A Project Description and the Location of the project should also be included (e.g., Construct new water treatment plant at 69 Mill Road in Village of Waterburgh). The applicant should provide information regarding the Population Served by the Water System and the Population Served by the Project.

Has the project been listed in a previous DWSRF Intended Use Plan (IUP)? If a pre-application has previously been submitted it is not necessary to complete an additional application form. If project information, contact information, actual or targeted activity dates, or project cost estimates previously submitted have changed, the applicant may wish to submit a revised pre-application form. If so, please include the DWSRF project tracking number.

Indicate if other funding sources (i.e., Rural Development, Housing and Urban Development, etc.) are available for the project. If other sources of funding are available please attach a separate sheet of paper and include the funding source, funding amount, type of funding (i.e., grant, low interest loan), and date the funding was granted (letter of confirmation).

Contact Information

DOH will be using the contact information provided on the pre-application form to identify the borrower, the consulting engineer, and other key project contacts (if applicable). Individuals listed on this portion of the pre-application form may be contacted directly by DOH staff to answer technical questions.

Project Cost Estimate

The accuracy of project costs will vary depending on the stage of project development. Please use the best available estimate when completing the form. Cost estimates should be provided for Construction Costs, Engineering Fees (planning fees, design fees, and construction fees), Other Expenses (legal expenses, bond counsel costs, force account costs, fiscal expenses, interest during construction, and miscellaneous expenses), Equipment Costs, Land Acquisition Costs, and Contingencies. Financial assistance anticipated from other Funding Sources (Rural Utilities, Housing and Urban Development, etc.) should be subtracted from the
Subtotal Project Costs of the above listed cost estimates. The Estimated Issuance Cost (approximately 3% of project costs) should be added to the subtotal to determine Total Amount to Finance. If certain cost elements are unknown and cannot be reasonably estimated, please indicate on the form. Estimates for all expenses will eventually be needed so that sufficient monies for the project are included in the IUP.

Project Schedule

Provide the date (targeted or actual) when an approvable Engineering Report and all Technical Submittals will be completed. Required Technical Submittals include environmental review documents and findings, final plans and specifications, engineer's certification of technical requirements, certification of title to project sites, Minority & Women's Business Enterprise - Equal Opportunity (M/WBE-EEO) program documents. Additionally, the borrower should contact DOH and other responsible permitting agencies (e.g., New York State Department of Environmental Conservation) for anticipated review and issuance times. Please contact EFC for applicable loan application deadlines and anticipated loan closing dates.

Provide the date (targeted or actual) of Start of Construction (i.e., date Notice to Proceed was issued). Although the construction schedule may be very tentative when you complete the pre-application, it is important to set target dates as they indicate when DWSRF financing will be needed.

Indicate if the project is being submitted for Refinancing. If the project is being refinanced, include the actual date of Construction Completion.